DESCRIPTION (provided by investigator): The proposed Mexican Chronic Renal Insufficiency Cohort Study is collaboration between a U.S. based NIH- funded investigator, James P. Lash, MD and Magdalena Madero, MD, a nephrologist at the Instituto Nacional de Cardiologia Ignacio Chavez in Mexico City. In Mexico, chronic kidney disease (CKD) represents a growing public health problem, with an increase in prevalence of 11% per year in the last 10 years. Furthermore, CKD is the third most common cause of in-hospital mortality in Mexico. Despite the magnitude of this problem, little is known about the epidemiology of CKD in Mexico. A better understanding of risk factors for progression of CKD is of critical importance because less than one-half of patients with kidney failure in Mexico have access to dialysis or kidney transplantation. The overall objective of this application is to recruit and retain a cohort of 340 Mexicans with mild-to-moderate CKD. Preliminary data generated during the period of support will be utilized to apply for extramural funding to extend participant follow-up in order to accomplish the following long- term Specific Aims: 1) Identify risk factors for progression of kidney disease in Mexicans with CKD; 2) Identify risk factors for cardiovascular events and progression of subclinical cardiovascular disease; 3) Evaluate the association between CKD and other clinical outcomes such as functional status, quality of life, and depression; and 4) Compare rates of CKD progression between Mexicans with CKD living in Mexico and Mexicans with CKD living in the U.S. The proposed study will leverage the infrastructure of an active NIDDK-funded research program which is focused on investigating the epidemiology of CKD in U.S. Hispanics and non-Hispanics (Principal Investigator Lash, R01 DK72231, and U01 DK60980) and the extensive training resources available at the University of Illinois at Chicago School of Public Health. This application fulfills the mission of the Fogarty International Research Collaboration Award program by building epidemiologic CKD research capabilities in Mexico and providing training in research methodology for Dr. Madero and other trainees at her institution. Furthermore, the knowledge gained by the research has the potential to inform the design of future interventional trials with the goal of improving health outcomes for Mexicans with CKD.